How 988 Works as a Suicide Prevention Hotline

If you or a loved one are having thoughts of suicide or self-harm, you’re not alone — and sometimes, that knowledge is the most important thing to remember. Asking for help when you need it and leaning on others for support without judgment is key to survival for many of us.

“When you have depression or anxiety and you’re not being treated, your symptoms can get worse. Unfortunately, most patients aren’t seen until after they’ve already attempted suicide,” says psychiatrist Tatiana Falcone, MD. “But suicide is a preventable cause of death if you’re able to ask for help during your moments of crisis.”

The U.S. National Suicide Prevention Lifeline, now known as the 988 Suicide & Crisis Lifeline, made major improvements in July 2022 when it launched the new three-digit number to offer more comprehensive help to anyone experiencing a mental health crisis, in need of advice or for anyone concerned about a loved one.

When you contact or text 988 from anywhere within the United States, you’ll be connected to a network of local counselors who can guide you through whatever you’re facing. In the most serious circumstances, a 988 counselor can send a mobile response team of mental health professionals to your location or provide additional, long-term support should you need it.

Dr. Falcone explains how dialing 988 can help you and how the suicide hotline works.

What happens if you call 988?

988 functions like 911, but it’s specifically designed as a suicide prevention hotline to help people who are having trouble with their mental health. 988 offers support in English and Spanish and uses translation services in more than 250 additional languages. You can call, text or chat online with counselors for support, and when you call the original suicide hotline number (which is still active), you’ll be rerouted automatically to the 988 network.

988 is for anyone who needs someone to talk to in a moment of need. You may want to call 988 if you are:

• Feeling overwhelmed.
• Feeling anxious.
• Having a bad day.
• Struggling with being alone.
• Experiencing obstacles that feel insurmountable (like financial difficulty, issues with housing, access to food or having a safe place to sleep.)
• Thinking of self-harm or harming others.
• Thinking of death or suicide.
• Dealing with a crisis related to your gender identity or sexual orientation.
• Experiencing problems with substance use.
• Worried about your friends or family who are struggling.

When you call 988, you’ll be greeted by an automated voice system that will give you additional options in case you need specialized support as a veteran or a member of the LGBTQIA+ community.

Then, your call will be rerouted to a local call center closest to you based on your area code. If those call centers are busy, your call will be rerouted to another national call center, with the goal of answering your call within 20 seconds. When a trained counselor answers the phone, they’ll ask you what’s troubling you and listen to what you tell them in a nonjudgmental way.

What to say when you call 988

It’s important that you share your story and describe how you’re feeling in as much detail as you’re comfortable. Being honest about what’s troubling you and the severity of your thoughts and feelings are key to this experience. Take the time to describe your physical and emotional symptoms, as well as what you’re thinking. If you’ve made a plan to hurt yourself or others, you should share that plan with the counselor because it can help them walk you through what’s happening. There’s no shame in being honest about your condition.

“It’s very important to be honest about the intensity of your symptoms because it helps us determine the chances of you hurting yourself,” says Dr. Falcone. “You have to think of it like any other consultation you would have when you feel sick. If you go to the emergency room because you have pneumonia but you don’t tell them that you’re coughing or that you have a fever, it’s very hard for them to provide the special care that you need in order to feel better.”

The conversation you have with your counselor is confidential and it doesn’t go in your medical record. They may ask you a series of follow-up questions about whether you’re thinking of harming yourself or having suicidal thoughts. They may also guide you through healthy strategies and coping mechanisms so you can better tackle the problems you’re facing. And if you’re comfortable, they can contact your therapist if you give them permission.

What extra support can 988 provide?

If you’re concerned you may harm yourself or others and you want to be connected to emergency support services or additional mental health services, they can send a mobile response team of trained professionals to your location or help you find the right services you need during this difficult time.

“Mobile crisis response teams aren’t available in all places, but when it’s available, it’s a great resource because it can help you manage your crisis in the moment,” says Dr. Falcone.

If you’re unsure about asking for further assistance, it can, again, be helpful to think about mental health illnesses like any other physical condition.

“If you’re having a heart attack, you want help right now because it’s a crisis,” notes Dr. Falcone. “If you’re having suicidal thoughts, you need help right now, too.”

When the call is done, your counselor may schedule a follow-up call at a later time to check in on you and see how you’re doing or if you need any additional support.

“When you’re seeing that your symptoms are getting worse and you’re using all the coping mechanisms you know and you’re not getting better or you’re feeling hopeless, that may be the time to ask for more help,” says Dr. Falcone.

How does 988 improve the old suicide hotline?

Thanks to $432 million of federal funding, the new 988 lifeline builds on the old one by expanding its network, strengthening its infrastructure and focusing on connecting callers to local mental health resources.

Many of these changes were designed to improve how quickly calls are answered in an effort to make sure you don’t have to wait long when you need help right now.

Just one month after launching 988, counselors answered calls, texts and chats within an average speed of 42 seconds — much faster than in 2021, when it took an average of 2 minutes and 30 seconds for those same encounters to be answered. When you consider that every second counts in moments of crises, that alone is a big improvement.

Additionally, 988 has seen an increase in chat and text usage. In August 2022, the suicide prevention hotline received 104,742 chats and texts — 37% more than the previous year — and they were able to answer them 13 times faster than in 2021.

The changes to 988 don’t stop at the suicide hotline itself, either. 911 dispatchers now route mental health emergency calls to 988. Crisis intervention specialists are not police. They’re trained to approach mental health crises in nonviolent ways and they can send a mobile response team of mental health professionals to your home when emergencies happen if that service is available to you locally. If those services aren’t available, they’ll work to send EMS instead. They can also provide additional resources, if needed, including access to short-term or long-term mental health facilities.

“Having a three-digit number that connects you to a specialized counselor who can help manage your symptoms before you have a suicide crisis is very important because they can tailor their help to your needs,” explains Dr. Falcone. “Interventions like this are lifesaving.”

Suicide prevention

If you’re experiencing a mental health crisis, you don’t have to go through it alone, no matter how big or small it may seem. Sometimes, you need help from more than just your family and friends — and that’s OK.

If you feel unsafe or unable to share your experiences with people who are close to you, or if you feel that you need more help than they can provide, reach out to a healthcare provider, who can connect you with a therapist for confidential mental healthcare. And if you’re having a particularly difficult moment or just need an unbiased point of view from someone who will listen to your needs and care about your well-being, calling 988 is a great option.

The important thing to remember is that you don’t have to wait until you’re at your lowest to call the suicide hotline or ask others for help. When you’re feeling unwell or even need the smallest bit of help, it’s OK to reach out.

“We don’t want things to get to the point where you can’t do anything else,” encourages Dr. Falcone. “When you’re having a bad day or you’re having a lot of negative thoughts, sometimes, it’s hard to see all of the choices you can make. Lifeline counselors can walk you through different tools that you can use to cope in the moment and help you see the big picture from another perspective.”